MR. MADISON D PETTIGREW MSN APN PMHNP-BC NPI 1912211764

NPI Information

NPI: 1912211764
Provider Name: MR. MADISON D PETTIGREW, MSN, APN, PMHNP-BC
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

PECOS Registration: Yes

Address:
8130 COUNTRY VILLAGE DR STE 103
CORDOVA, TN
ZIP 38016
Phone: (901) 308-2915
Get Directions

MR. Madison D Pettigrew, MSN, APN, PMHNP-BC is a psychiatric/mental health nurse practitioner in Cordova, TN with 4 years of experience. MR. Madison D Pettigrew, MSN, APN, PMHNP-BC NPI is 1912211764. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

8130 COUNTRY VILLAGE DR STE 103
CORDOVA, TN
ZIP 38016-087
Phone: (901) 308-2915
Fax: (901) 308-2924

The NPI 1912211764 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/4/2010 and was last updated on 8/1/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	163W00000X	Registered Nurse		171949	TENNESSEE	No
2	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	904213	MISSISSIPPI	No
3	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	28484	TENNESSEE	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	T24221A	MEDICAID	TENNESSEE
2	1I5219	OTHER	MISSISSIPPI	MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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